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Background: Cerebrovascular diseases (CVDs) are a major and potentially increasing burden to public health. Digital health interventions (DHIs) could support access to and provision of high-quality health care (eg, outcomes, safety, and satisfaction), but the design and development of digital solutions and technologies lack the assessment of user needs. Research is needed to identify opportunities to address health system challenges and improve CVD care with primary users of services as the key informants of everyday requirements., Objective: This study aims to identify opportunities for DHIs from clients' and health care professionals' perspectives to address health system challenges and improve CVD care., Methods: This study used a qualitative, descriptive approach. Semistructured, in-person interviews were conducted with 22 clients and 26 health care professionals in a single tertiary-level hospital in Finland between August 2021 and March 2022. The data were analyzed using a deductive and inductive content analysis., Results: Identified opportunities for DHIs in CVD care were organized according to clients, health care professionals, and data services and classified into 14 main categories and 27 generic categories, with 126 subcategories of requirements. DHIs for clients could support the long-term management of health and life changes brought on by CVD. They could provide access to personal health data and offer health information, support, and communication possibilities for clients and their caregivers. Health care professionals would benefit from access to relevant patient data, along with systems and tools that support competence and decision-making. Intersectoral and professional collaboration could be promoted with digital platforms and care pathways. DHIs for data services could enhance care planning and coordination with novel predictive data and interoperable systems for data exchange., Conclusions: The combined study of client and health care professional perspectives identified several opportunities and requirements for DHIs that related to the information, availability, quality, acceptability, utilization, efficiency, and accountability challenges of health systems. These findings provide valuable social insights into digital transformation and the emerging design, development, and use of user-centered technologies and applications to address challenges and improve CVD care and health care., (©Henna Härkönen, Kirsi Myllykangas, Mikko Kärppä, Kirsi Maaria Rasmus, Julius Francis Gomes, Milla Immonen, Piia Hyvämäki, Miia Jansson. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 02.12.2024.)

Background: Digital transformation is an ongoing sosio-technological process that can create opportunities in the health sector. However, the current landscape of digital transformation in hospital-at-home care is unknown., Aim: To describe healthcare providers' perspectives of digital transformation in hospital-at-home care., Methods: A total of 25 semi-structured interviews were conducted in September-October 2023 in all Finnish wellbeing services counties (n = 21), the city of Helsinki (n = 1), and private health care providers (n = 3). Snowball sampling was used (N = 46). The data underwent an inductive content analysis., Result: The analysis revealed four main and 17 generic categories of challenges and opportunities of digital transformation in hospital-at-home care. These challenges and opportunities were related to 1) Health information exchange in and across hospital-at-home care; 2) Management of hospital-at-home care; 3) Logistics in hospital-at-home care planning and delivery; and 4) Digital health interventions in hospital-at-home care delivery., Conclusions: The challenges and opportunities of digital transformation in the hospital-at-home care is intricately linked to the efficiency of health information exchange, management, logistics, and digital health interventions. Addressing the key areas of improvement in health information exchange can lead to more streamlined patient care processes and improved communication between healthcare professionals and patients. Digital transformation in management and logistics can improve overall efficiency within healthcare systems. Digital health interventions may promote equitable and universal access to high-quality healthcare. Continued focus on health care information infrastructure, in particular interoperability of electronic health records and optimization of information flow, will be essential to realize the full potential of digitalization., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: While digital health and social services offer promising solutions, they often overlook the perspectives and needs of older adults. This study aims to comprehensively investigate the preferences of older adults regarding the use and development of digital health and social services., Methods: The survey spanned from 19 March to 31 March 2023. The study population comprised 1100 Finnish individuals aged 75 and over from across Finland. The study used qualitative inductive content analysis to examine the open-ended responses obtained in the survey., Results: We identified eight main categories for the older adults' preferences: usability, service design, and security; training, support, instructions, and information; flexibility of compatible devices; understandable language and interpretation of laboratory results; available and accessible services; desired functionalities; delivery of information for viewing, and personalization., Conclusions: Older adults' involvement in digital services' strategy development is crucial, emphasizing value co-creation and segmentation while avoiding value co-destruction. Segmenting users and understanding their needs aids in customizing services, improving healthcare provision. Further research should assess the impact of segmentation-based training and digital device provision on older adults' adoption of digital health and social services., (© 2024. The Author(s).)

Aim(s): To understand patients' and healthcare professionals' experiences to improve care in and across different domains of the cerebrovascular disease pathway., Design: A qualitative descriptive study., Methods: Semi-structured in-person interviews were conducted among 22 patients diagnosed with acute cerebrovascular disease and 26 healthcare professionals taking care of them in a single tertiary-level hospital from August 2021 to March 2022. Data were analysed using deductive and inductive content analysis. The consolidated criteria for reporting qualitative research was used to ensure reliable reporting., Results: Overall, 19 generic and 79 sub-categories describing perceived challenges with 17 generic and 62 sub-categories describing perceived needs were identified related to primary prevention, organization of stroke services, management of acute stroke, secondary prevention, rehabilitation, evaluation of stroke outcome and quality assessment, and life after stroke., Conclusion: Several challenges and needs were identified in and across the different domains of the cerebrovascular disease pathway. There is a requirement for adequate resources, early initiation of treatment, early diagnostics and recanalization, dedicated rehabilitation services, long-term counselling and support, and impact evaluation of services to improve cerebrovascular disease care. Future research on caregivers', and clinical leadership experiences in and across the cerebrovascular disease pathway is needed to explore the provision of services., Implications for the Profession And/or Patient Care: The results of this study can be applied by organizations, managers and research for developing and improving services in the cerebrovascular disease pathway., Impact: This study identified several patient-related, organizational and logistical needs and challenges, with suggestions for required actions, that can benefit the provision of effective, high-quality cerebrovascular disease care., Reporting Method: We have adhered to relevant EQUATOR guidelines with the COREQ reporting method., Patient or Public Contribution: No patient or public involvement., (© 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Aim: To describe patients' experiences of the quality of counselling to develop new digital counselling solutions for patients with cerebrovascular disease., Design: A descriptive, qualitative approach., Methods: Semi-structured in-person interviews were conducted among 22 patients diagnosed with acute cerebrovascular disease and treated as inpatients at a single university hospital in Finland between September 2021 and February 2022. Data were analysed using deductive and inductive content analysis., Results: The identified facilitators, barriers and possible solutions for the development of new digital counselling solutions were deductively categorized into five main categories: (1) background factors, (2) resources, (3) implementation, (4) sufficiency, and (5) effects and 12 generic categories. Patients with cerebrovascular diseases worry about symptoms affecting their ability to receive information and valued a supportive atmosphere. Staff should have more time for counselling and use motivational digital counselling solutions in plain language, moderate length and with multimedia content. Patients desired reminders, easy search functions and possibilities for two-way communication., Conclusion: New digital counselling solutions could be beneficial in supporting the patients' knowledge, emotions and adherence. For the success of such solutions, patients' special needs concerning different levels of cognitive impairment need to be considered., Impact: The results of this study may benefit healthcare organizations in the development of digital counselling solutions that meet the patients' needs., Reporting Method: We have adhered to relevant EQUATOR guidelines with the COREQ reporting method., Patient or Public Contribution: Patients were involved as the study population., (© 2024 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: Digital services can be effective and cost-efficient options for treating non-communicable diseases, but generalizability is limited due to heterogeneous treatment effects. This umbrella review aims to evaluate the impact of digital services on population health, costs, and patient and healthcare professional satisfaction, and to identify facilitators and barriers to using digital services in healthcare and social welfare., Methods: The protocol of the study was registered on the 4th of September 2022 to the International Prospective Register of Systematic Reviews, PROSPERO (CRD42022355635). The review was performed using the Centre for Reviews and Dissemination, Cochrane, Ovid Medline, Scopus, and Web of Science in June 2022. The methodological quality of the included reviews was assessed. The impact of digital services was categorized as no evidence, no dominance, and mixed and positive effect. Inductive content analysis was used to identify facilitators and barriers., Results: A total of 66 studies were included in the review, 64 % of which were evaluated as high quality. Studies on the impact of digital services in social welfare were not identified. Sixty-five percent of reviews evaluated the impact of digital services on population health with mixed effects; 21 % were on costs with mixed effects; 27 % were on patient satisfaction with positive effects; and 7.6 % were on healthcare professionals' satisfaction with mixed effects. Various features, allocation, end-user support, organized services, and service development facilitated the use of digital services. Correspondingly, barriers were related to service limitations, digital competency, funding- and service strategies, resources and change management., Conclusions: Compared to usual care, digital services had a mixed impact on population health and costs with high satisfaction in patients. Mixed healthcare professionals' satisfaction was associated with the use of digital services, and it was less studied. To ensure successful implementation and sustainability of digital services, attention must be paid to address barriers and supporting facilitators at all levels., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Diastrophic dysplasia (DTD) is a rare osteochondrodysplasia characterized by short-limbed short stature and joint dysplasia. DTD is caused by mutations in SLC26A2 and is particularly common in the Finnish population. However, the disease incidence in Finland and clinical features in affected individuals have not been recently explored. This registry-based study aimed to investigate the current incidence of DTD in Finland, characterize the national cohort of pediatric subjects with DTD and review the disease-related literature. Subjects with SLC26A2 -related skeletal dysplasia, born between 2000 and 2020, were identified from the Skeletal dysplasia registry and from hospital patient registry and their clinical and molecular data were reviewed. Fourteen subjects were identified. Twelve of them were phenotypically classified as DTD and two, as recessive multiple epiphyseal dysplasia (rMED). From the subjects with available genetic data, 75% (9/12) were homozygous for the Finnish founder mutation c.-26+2T>C. Two subjects with rMED phenotype were compound heterozygous for p.Arg279Trp and p.Thr512Lys variants. The variable phenotypes in our cohort highlight the wide spectrum of clinical features, ranging from a very severe form of DTD to milder forms of DTD and rMED. The incidence of DTD in Finland has significantly decreased over the past decades, most likely due to increased prenatal diagnostics.

The excretion of starch, enzyme-resistant starch, dietary fiber components and organic acids (short-chain fatty acids plus lactic acid) as well as plasma and urine lignans and isoflavonoids was studied in eight ileostomists consuming mixed diets with wheat bread (low fiber diet) or rye bread (high fiber diet) in a crossover design. Average ileal excretions of enzyme-available starch were 3.5 g/d during the low fiber period and 4.1 g/d during the high fiber period. The excretion of enzyme-resistant starch was approximately the same (2.3 g/d) in both periods. In comparison with intake, similar amounts of total fiber residues were excreted both by subjects receiving the low fiber diet (3.4 g/d) and by those receiving the high fiber diet (2.7 g/d). However, subjects excreted significantly more of certain polysaccharide residues (fucose, galactose, and uronic acids) than they ingested. On average, the excretion of organic acids was 18.6 mmol/d during the low fiber period and 30.2 mmol/d during the high fiber period. No significant differences in plasma lignans were observed between the high fiber and the low fiber dietary periods. The present findings indicate that enzyme-available starch is highly digested and that a microbial breakdown of dietary fibers and probably other carbohydrates occurs in the small intestine. However, the bacterial activity in the ileostomists was not sufficient to cause an increased level in plasma lignans even when subjects consumed the high fiber rye diet.

Study Design: This study compared isokinetic and non-dynamometric tests for their correlation with subjective low back pain symptoms., Methods: A total of 185 patients with chronic low back pain were examined., Results: The repetitive arch-up and sit-up tests correlated significantly with pain and disability (Million index) both in men and women (r ranged from -0.39 to -0.46; P < 0.001). In women, the isokinetic trunk flexion and extension tests and the non-dynamometric tests correlated equally well with the Million index. In men, the isokinetic flexion and extension tests had weaker correlations. Overall, the isokinetic lifting tests showed lower correlations than did the isokinetic trunk extension tests. In the isokinetic flexion and extension tests, fast testing speeds (120 degrees/sec and 150 degrees/sec) correlated somewhat better with the subjective symptoms than did the lowest speed (30 degrees/sec)., Conclusions: The non-dynamometric tests are still useful in clinical practice in spite of the development of more accurate muscle strength evaluation methods.

Objectives: In 1978, a cross-sectional study of 279 lumberjacks exposed to hand-arm vibration and 178 unexposed referents was conducted. The aim of the present study was to provide a seven-year follow-up on (i) the changes in the white-finger symptoms among the lumberjacks and the referents, (ii) the effect of white-finger symptoms on the professional prognosis of the lumberjacks, and (iii) the relationship between hand-arm vibration and changes in wrist bones., Methods: The methods consisted of a questionnaire, a routine clinical examination, and radiographs of the wrists and hands. The examinations were conducted as a field study using a mobile unit., Results: The prevalence of white-finger symptoms was 18% among the lumberjacks and 3% among the referents in the original study. Seven years later 213 lumberjacks and 140 referents participated in the follow-up. The prevalence of white-finger symptoms was 24.9 among the lumberjacks and 5.7 among the referents, and the seven-year cumulative incidence was 14.7% among the lumberjacks and 2.3% among the referents. After allowance for age, there was no difference in the incidence of white-finger symptoms between the lumberjacks with fewer than 15 years of exposure and the referents, but the risk increased with increasing duration of exposure (risk ratio 8.9, 95% confidence interval 2.5-28.9 for those exposed at least 25 years). There was no difference between the two groups in the prevalence of radiographically detectable translucencies or osteoarthrotic changes in the wrists and hands., Conclusion: According to the results, white-finger symptoms are still a problem among lumberjacks who started chain-saw work before 1970.

An oat bran concentrate was prepared by removing non-fibre components by cold-water wet-milling, resulting in a 2- to 3-fold concentration of soluble fibre, with beta-D-glucan as its main component. The concentrate was baked in bread which was consumed for 8 weeks by free-living men with mild to moderate hypercholesterolaemia. The effects on serum lipids were assessed in a randomized, double-blind, placebo-controlled trial. Despite the large daily dose (11.2 g) of beta-glucan, the beta-glucan-enriched bread had only a small and statistically non-significant effect on serum lipid concentrations. Probable reasons for the weakness of the effect could be the poor solubility of beta-glucan in the preparation, its enzymatic hydrolysis after ingestion, and the consequently low viscosity in the intestine.

A group of 98 male workers occupationally exposed to styrene was interviewed for information on the amount and frequency of alcohol consumption and changes in consumption frequency and tolerance. Alcohol consumption and changes in consumption were not compared to any reference data, but the changes in tolerance were. The styrene-exposed workers revealed a lowered tolerance somewhat more often than the unexposed group. Neither the duration nor the intensity of styrene exposure was related to any of the alcohol "behavior" variables. The amount of over-time work in exposure had a slight relationship to high alcohol consumption, but the interpretation of this relationship remains undecided. Subjective symptoms, like hand tremor and difficulties in staying asleep, were associated with the alcohol "behavior" variables, but these two symptoms were unrelated to intensity of styrene exposure. Of the psychological functions studied, lowered visuomotor speed showed a slight relationship to high alcohol consumption. Visuomotor inaccuracy, which had proved to be related to a high intensity of styrene exposure, revealed no connection with the alcohol "behavior" variables. It was concluded that alcohol consumption among styrene-exposed workers is not related to the same psychological symptoms and signs as styrene exposure.

Spinal mobility and posture were measured and their correlations with growth velocity were calculated in 30 boys and 30 girls aged 13 to 14. The spinal measurements were carried out by noninvasive goniometric methods. In the thoracic spine kyphosis (P less than 0.01), forward flexion (P less than 0.01) and the sum of lateral flexions (P less than 0.05) were reduced in the girls compared with the boys. In the boys and girls alike, thoracic rotation to the left was smaller than to the right, but the difference was statistically significant (P less than 0.05) only for the girls. In the girls, thoracic forward flexion and rotation to the left had negative correlations (r = -0.38 and -0.39, P less than 0.05) with growth velocity. The hypothetical significance of the results for the explanation of the development of adolescent idiopathic scoliosis is discussed.

To evaluate the possible embryotoxic effects of styrene, 67 female lamination workers occupationally exposed to styrene and 67 age-matched female industrial workers with no obvious chemical exposure were interviewed. The women, all under 40 a of age, did not differ significantly with respect to number of births, pregnancies, or spontaneous and induced abortions prior to the exposure period. During the styrene exposure the number of births was significantly lower among the exposed group, a result partly explained by a higher number of induced abortions. No differences were found in this material with regard to the number of spontaneous abortions.

The lung function of 7 men accidentally exposed to sulfur dioxide (SO2) in a pyrite dust explosion was followed for 4 yr. The greatest decrease in forced vital capacity, forced expiratory volume in one second, and maximal midexpiratory flow was observed 1 wk after the accident. After about 3 months no further decrement occurred. The pattern of spirometric findings was obstructive in 6 and restrictive in 1 of the patients. Four years after the accident a reversible obstruction of the bronchi was still observable in 3. Four patients reacted positively to the histamine challenge test. Two patients either did not respond to bronchodilator or did not react to histamine. The results suggest that bronchial hyperreactivity is a frequent sequela after exposure to high concentrations of SO2. The hyperreactivity may persist for several years.

Twenty immunological parameters were determined for 37 asbestos-exposed workers with no radiographic pulmonary fibrosis and 132 asbestosis patients, 37 of whom formed a matched referent group for the non-diseased workers. No clear differences between the matched groups were found for the autoantibodies tested, but the prevalence of autoantibodies was increased in both groups in comparison with the prevalence among Finnish blood donor candidates. This phenomenon may reflect a general immunological activity caused by asbestos dust, and this immunological activity may act as an adjuvant in immunisation. The patients revealed a high level of IgA, C3, C4 and alpha-1-antitrypsin. This result indicates that these factors may be related to the development of asbestosis, and could therefore be utilized in the evaluation of diffuse pulmonary fibrosis among workers with asbestos exposure.

Spray finishing operations often involve cleaning with solvents. White spirit is widely used as a solvent in car washes in Finland. The purpose of the present study was to determine the levels of solvent exposure of car washers and to evaluate the effectiveness of ventilation systems in car washing facilities. The study covered 11 car washes. Airborne solvent concentrations were measured both in workers' breathing zones and at stationary sampling sites. The solvent concentration in the breathing zones ranged from 5 to 465 mg/m3 during the washing of automobiles and from 45 to 685 mg/m3 during the washing of heavy vehicles. Brief concentration peaks up to 4,500 mg/m3 were detected. The flow rate of ventilation air ranged from 0.3 to 3.9 m3/s. The greatest reduction in solvent concentration in the workers' breathing zones was attained with a ventilation design where the supply air jets blew directly into the work zone.

The liver functions, as reflected by the serum enzyme activities of aspartate aminotranferase, alanine aminotransferase, and gamma glutamyl transferase and by the concentrations of cholic acid and deoxycholic acid, of 34 styrene-exposed and 34 reference female workers were followed prospectively for a year. The mean age of exposed workers was 34.2 years, mean duration of past exposure 5.1 years. The mean age of the referents was 30.7 years. During the follow-up period blood samples were collected three times for the determinations. The history of possible liver disease and alcohol consumption was ascertained by questionnaire. Altogether 87 samples of both groups were analyzed. The styrene-exposed group did not have higher values for any measurement when compared with those of the referents. Two persons in both groups had one sample with transaminase activities exceeding laboratory reference values. The abnormal values were associated with the use of drugs or alcohol. Cholic acid and chenodeoxycholic acid concentrations were of the same magnitude in both groups.

Excretion of mandelic acid from workers in the reinforced polyester plastic industry was studied with the determination of urinary mandelic acid concentrations. The styrene exposure level at the workplaces was evaluated with measurements of the styrene concentration in the ambient air. Three different groups (I, II and III) were studied. In group I [n=9, median of the time-weighted average (TWA) of exposure = 23 ppmof styrene, postexposure observation period = 64 h] two excretion slopes were observed, the first with a median half-time of 9.4 h (postexposure period 0--18 h) and a second with a median half-time of 16.6 h (postexposure period 19--64 h). For group II (n=9, median TWA exposure = 248 ppm, postexposure observation period = 15 h) a half-time of 6.4 h was found. These results suggest that the excretion rate of mandelic acid is dependent on the styrene exposure level. In addition the mandelic acid concentrations of 29 workers (group III) before and after the work shift were analyzed. The urinary mandelic acid concentrations of groups I, II and III, sampled immediately after the 8-h work shift, correlated with the 8-h TWA of styrene exposure (n=47, r=0.93). Accordingly about 2,300 mg of mandelic acid per gram of creatinine corresponded to 100 ppm of styrene.

The relationship between long-term occupational styrene exposure and disturbances in psychological functions was studied. The exposed group consisted of 98 male workers exposed to styrene in the manufacture of polyester plastic products, and the comparison group comprised 43 concrete reinforcement workers. The duration of exposure in years and the mean mandelic acid concentration in urine (five determinations during 5 weeks before the clinical examination) and the cumulative dose of exposure were used as the indicators of exposure. The psychological functions studied were intelligence, visuomotor speed, visuomotor accuracy, memory, vigilance, and psychomotor performance. Some personality test variables were also included. In a group comparison two variables (visuomotor inaccuracy and poor psychomotor performance) out of 20 showed statistically significant differences and characterized the styrene exposed group. These findings were confirmed when workers with low and high styrene exposure were compared. One variable measuring visuomotor speed and another measuring visual memory were related to the duration of exposure (R = 0.28, p less than 0.05). In a multiple regression analysis disturbances in visuomotor accuracy, poor psychomotor performance, and lowered vigilance proved to have some connection with a high mandelic acid concentration (R = 0.49, p less than 0.01). In addition workers with disturbances in visuomotor accuracy and slight disturbances in virumotor speed had higher mandelic acid concentrations when compared with those workers without any deterioration. The results indicate that disturbances in visuomotor accuracy and, to a lesser degree, in psychomotor performance are the main findings measured by test methods used in this study and related to one indicator of styrene exposure, mandelic acid concentration. The psychological methods used revealed subclinical symptoms related to exposure, and they should aid in making group diagnoses, e.g., when additional information is needed for the determination of the threshold limit value. The deterioration found in visuomotor accuracy could be related to lowered safety in work and traffic.

In a cross sectional study 279 lumberjacks exposed to chain saw vibration and a reference group of 178 peat bog workers were examined. The mean ages of the two groups were 34.6 and 33.1 years, respectively. The lumberjacks' mean duration of exposure to vibration was 10.4 years. The study consisted of a questionnaire and a clinical examination, including radiographs of the wrists. The prevalence of reported white finger symptoms was 18% for the lumberjacks and 3% for the referents, whereas that of numbness in the upper extremities was 51% and 22%, respectively. Among lumberjacks the occurrence of white finger symptoms increased significantly with the duration of exposure to vibration but was not associated with age or smoking. The prevalence of the numbing of the upper extremities increased linearly with age in both groups, but it was not associated with duration of exposure after adjustment for age. Among lumberjacks there was a significant association between the numbing symptom and the white finger symptom, but not among the referents. A high prevalence of numbing in the upper extremities among the lumberjacks could be at least partly explained by occupational factors other than vibration--work posture, for example. Radiographically, cysts were found in the wrist bones of 8-9% of both groups. The exposure to chain saw vibration no longer seems to be a determinant in the development of vacuoles in the carpal bones.

For the study of the relationship between styrene exposure and symptoms and signs of central nervous dysfunctions, 98 male workers occupationally exposed to styrene were given clinical, neurophysiological and psychological examinations; also a symptom survey was made. Urinary mandelic acid concentrations, measured once a week during five consecutive weeks, were used to express the exposure intensity. Different unexposed groups were used for reference. No exposure-response relationship was observed between symptoms of ill health and the urinary mandelic acid concentration, although the exposed group as a whole expressed significantly more symptoms than the reference group. The occurrence of abnormal electroencephalograms was about 10% in the group of workers with mandelic acid concentrations below 700 mg/l, but it was 30% among those whose mandelic acid concentration exceeded 700 mg/l, a level corresponding to the 8-h time-weighted average (TWA) of styrene exposure of about 30 ppm. With regard to psychological functions, the first change in visuomotor accuracy became discernible when the urinary mandelic acid concentration exceeded 800 mg/l. A more pronounced decrement appeared in both visuomotor accuracy and psychomotor performance when the mandelic acid concentration exceeded 1,200 mg/l, which corresponds to an 8-h TWA of styrene exposure of about 55 ppm.

The prevalence of congenital malformations among children born to styrene-exposed male and female workers, as well as the mortality of the exposed workers, was studied. A cohort of 2,209 workers (1,698 men, 511 women) was selected from the personnel files of 160 workplaces using styrene in the manufacture of reinforced plastic products. The earliest exposure histories began in 1960, but the majority of workers had been exposed after 1967. The data on children born to the exposed workers were linked with those of the Register of Congenital Malformations. The number of malformations of children born to the workers was, both before and during the styrene exposure, below the expected values. In the cohort there were 37 observed deaths (expected 74.0), six of which were due to cancer (expected 13.0). The cancer sites were the stomach (2 cases), bronchus (1), breast (1), ovary (1), and kidney (1 case). There were no cases of lymphatic or haematopoietic cancer. Most of the cancers appeared after short exposure times and soon after the commencement of exposure.